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When only paper bags work and plastic won’t do

Sunday, March 24, 2013 12:31 PM

This tale began somewhere above 30,000 feet soon after leveling off and heading east  a cabin attendant requested assistance from any physician aboard.

This was totally out of the blue, so to speak, and I was the only one to raise a hand. When an emergency presents, real or perceived, I cant hide. But just imagine the pucker factor of a situation at cruise altitude.

Well, there were probably a hundred or more passengers, though understanding, who might miss their connections or those awaiting them at their destination. They could be compelled to spend an unplanned night somewhere if the aircraft had to divert for an airport with a nearby hospital. A ripple effect would follow  rescheduling aircraft, crews and routes. These scenarios flash through my mind in less time than it takes to describe them. The flip side might be arriving on schedule with a deceased person  even less desirable.

I was led to a man seated at either the window or middle seat  no room to do anything. We cleared an exit row, moved him there, and stretched him out. With no equipment, stethoscope, blood pressure cuff  nothing  an examination would be by eyes, ears and hands. He was dizzy, a little pale, fearful, breathing rapidly and had some chest tightness, maybe pain. While his respirations were fast, they were not labored and the ratio of inspiration to expiration was normal. Pulse was a little fast, regular and strong.

There was no history of asthma and no audible wheezing, the most common cause of difficulty breathing in the young  he was younger than 30, and risk increases greatly with advancing age. He took no medications, had no chronic illnesses or history of hospitalizations, and no previous similar episodes. Another flight attendant came by. The captain wanted an update and asked if we needed to divert. I begged off and quickly ascertained that this was the young mans first airplane flight. I redirected the conversation to his family, his friends and his home life; I talked him down.

Hyperventilation (syndrome) is common, at least in emergency rooms. People under stress or anxiety  the summons, the divorce papers, the IRS notice  may react by breathing faster (and/or more deeply) and blow off carbon dioxide from their lungs and bloodstream. Falling CO2 causes a shift in blood pH and ionized calcium  affecting nerves and nervous system. The subjective sensation has been described as one of impending doom. There is often numbness and tingling in hands, feet and about the mouth, and even cramping paralysis of hands and feet known as carpopedal spasm.

Nurses often see these patients before the doctors do and treat them with a paper bag placed over the patients mouth. A paper bag, stiffer than plastic, forms a reservoir and recirculates expired CO2, increasing blood CO2, reversing the process in minutes. Its almost miraculous.

Some deny anxiety and doubt that mere rapid breathing can render them so sick. The attack can often (but not always) be reproduced by having a patient hyperventilate for several minutes.

End of story, our flight arrived on time.

www.alanfraserhouston.com. Dr. Fraser Houston is a retired emergency room physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.